Provider Demographics
NPI:1639143977
Name:KEOKUK AREA MEDICAL EQUIPMENT & SUPPLY, INC.
Entity Type:Organization
Organization Name:KEOKUK AREA MEDICAL EQUIPMENT & SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-526-8760
Mailing Address - Street 1:420 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3452
Mailing Address - Country:US
Mailing Address - Phone:319-524-6356
Mailing Address - Fax:319-524-6355
Practice Address - Street 1:420 N 17TH ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3452
Practice Address - Country:US
Practice Address - Phone:319-524-6356
Practice Address - Fax:319-524-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0104547Medicaid
MO622096006Medicaid
IA0104547Medicaid